乌拉地尔对急性前壁心肌梗死介入治疗后心肌无复流患者心室功能和收缩同步性的影响  

Effect of urapidil on heart function and ventricular systolic synchrony in acute myocardial infarction patients with no-reflow phenomenon after percutaneous coronary intervention

作　　者：陈金良[1] 傅向华[1] 姜云发[1] 范卫泽[1] 谷新顺[1] 刘津军[1] 耿巍[1] 

机构地区：[1]河北医科大学第二医院干部心血管科,石家庄050000

出　　处：《中国危重病急救医学》2008年第4期197-199,共3页Chinese Critical Care Medicine

基　　金：河北省自然科学基金资助项目（C2004000615）

摘　　要：目的探讨冠状动脉（冠脉）内注射乌拉地尔对急性心肌梗死介入治疗（AMI—PCI）后无复流患者心肌灌注分级（MBG）、左心室功能和收缩同步性的影响。方法43例首次AMI—PCI后无复流患者被随机分为乌拉地尔组（22例）和无复流对照组（21例）。从症状开始至PCI开通梗死相关动脉时间（6．25±2．37）h。均于PCI后即刻以硝酸甘油200μg冠脉内注入以排除冠脉痉挛。10min后乌拉地尔组冠脉内注射乌拉地尔5mg，无复流对照组给予等量生理盐水，余治疗相同。左心室造影测定心室容积、压力参数和室壁运动积分（WMS）；治疗后1周和6个月时行平衡法核素心室造影测定左室收缩、舒张功能和收缩同步性参数。结果乌拉地尔组和对照组PCI后即刻MBG分别为（0．77±0．31）级和（0．77±0．28）级。乌拉地尔组患者在治疗后10minMBG显著增加，为（2．37±0．27）级（P〈0．05）；与对照组比较，乌拉地尔组6个月时左室收缩期末容积指数、左室舒张期末容积指数、WMS和左室舒张期末压明显降低；核素心室造影左室射血分数、峰射血率和峰充盈率等明显升高；相位分析显示左室收缩同步性参数相角程（PS）、半高宽（FwHM）和峰相位标准差（PSD）亦明显降低（P均〈0．05）。结论冠脉内注射乌拉地尔可明显改善AMI—PCI后无复流患者MBG、左心室收缩和舒张功能，增加左室收缩同步性。Objective To evaluate the influence of intracoronary administration of urapidil on myocardial blush grade （MBG） and left ventricular systolic function and synchrony in the acute myocardial infarction （AMI） patients with no-reflow phenomenon after percutaneous coronary intervention （PCI） identified by MBG. Methods Forty-three patients with AMI, in whom primary PCI was successfully performed （6. 25±2.37） hours after the onset of angina pectoris,were found to have no-reflow phenomenon. They were randomized into two groups： urapidil group （n= 22） and no-reflow control group （n= 21）. Nitroglycerin （200μg） was injected into coronary artery. Urapidil （5 mg） was injected into coronary artery after 10 minutes in the urapidil group, and 0.9% NaCI （5 ml, weight percentage） was injected into coronary artery in the no-reflow control group. All the patients received same standard therapy afterwards. The left ventriculography （LVG） was performed immediately and 6 months after PCI to measure the ventricular volume, left ventricular end-diastolic pressure （LVEDP）, and wall motion score （WMS）. Equilibrium radionuelide angiography （ERNA） was performed 1 week and 6 months after PCI to determine the parameters of left ventricular systolic function and systolic synchrony. Results The MBG of urapidil group and control group was grade 0.77±0.31 and grade 0.77±0.28 after PCI, respectively. The MBG remained unchanged in control group and significantly increased from grade 0.77 ± 0.31 to grade 2.37 ± 0.27 10 minutes in urapidil group （P±0.05）. Follow-up at 6 months after AMI-PCI, left ventricular end-systolic volume index （LVESVI）, left ventricular end-diastolic volume index （LVEDVI）, WMS and LVEDP were significantly lower in urapidil group compared with those in control group respectively （all P〈0.05）. The values of left ventricular ejection fraction （LVEF）, peak ejection rate （PER）, peak filling rate （PFR） of the ERNA as measured by ERNA were signi

关 键 词：心肌梗死 急性 乌拉地尔 冠状动脉介入治疗 无复流 心肌灌注分级 

分 类 号：R542.22[医药卫生—心血管疾病] R732.1[医药卫生—内科学]